What is Restless Legs Syndrome?

Restless legs syndrome (RLS), also known as Willis-Ekbom disease, is a chronic condition that causes strong, unpleasant feelings in the legs, resulting in an overwhelming need to move them. Moving the legs relieves the unpleasant sensations.[1][2][3]

RLS is considered a condition of the nervous system, sometimes referred to as a neurological disorder. Because RLS can seriously affect some people’s sleep patterns, it can also be classed as a sleep disorder.[4][5]

Around eight percent of the population of the U.S.[6] is thought to be affected by RLS. Symptoms often begin at around 40 to 45 years of age, more often affecting women than men. This is known as late-onset restless legs syndrome.

Early-onset restless legs syndrome is when the condition appears before the age of 45, with symptoms rarely starting as early as during childhood. Early-onset restless legs syndrome appears to be more likely to run in families than the late-onset version of the condition.[7][8]

People affected by other conditions, such as iron deficiency anemia[1] or Parkinson’s disease[9] may also show symptoms of restless legs syndrome. These symptoms can also sometimes appear during pregnancy.

Restless legs syndrome cannot be cured. However, there are various treatments, including home remedies, lifestyle changes, and natural treatments, that can lessen the severity of symptoms. If RLS is triggered by a specific condition or medication, treating that condition can eliminate RLS.[2]

Symptoms: What does restless leg syndrome feel like?

The main symptom of RLS is an overwhelming urge to move the legs because of uncomfortable and unpleasant feelings in one or both legs.

The sensations in the legs and, in severe cases, the arms are variously described as:[1][10][11]

  • Crawling
  • Itching
  • Aching
  • Throbbing
  • Pulling
  • Burning
  • Painful
  • Fizzing
  • Tickling
  • Tingling
  • Feeling the urge to move
  • Cramping
  • Restlessness
  • Creeping
  • Causing discomfort
  • Tenseness
  • Having an electric current

Some people may experience the feelings as painful, but most people feel the sensations as an ache rather than sharp or sudden pain.[2]

When does restless leg syndrome happen?

Symptoms occur when the person is at rest or inactive, such as:[6][10]

  • Lying down
  • Sitting
  • In bed
  • In a restricted space, like on a plane or at the movies

As a person is more likely to be at rest in the afternoon and evening, those are the parts of the day when RLS symptoms are usually at their worst. For some of those affected by RLS, the symptoms may only occur occasionally, while for others they are present every day.

Symptoms tend to improve in the mornings with getting up, and whenever the person starts to move or walk around.[1] Moving around as a remedy can cause problems when the person is trying to go to sleep.

Symptoms can vary in severity, from mild discomfort to being so disruptive and painful they affect day-to-day life. Sleep can be so disturbed that people have difficulty functioning during the day, which can commonly lead to depression and anxiety.[1][12][11]

Worried you may have RLS?, check your conditions Adoctor conditions.

Periodic limb movement in sleep (PLMS)

Periodic limb movement in sleep (PLMS), also known as periodic limb movement disorder (PLMD)[3], is experienced by about 80 percent of people with restless legs syndrome.[13]

Periodic limb movement in sleep causes limbs, commonly the legs but also sometimes the arms, to jerk or twitch involuntarily during sleep. It can be so severe as to wake the sleeper and disturb anyone sharing the bed. Involuntary limb movements may also occur during waking hours when it is known as periodic limb movement during awakening (PLMW or PLMA).[13]

Most people with restless legs syndrome have PLMS, but many people with PLMS do not also have restless legs syndrome.[14]

Causes of restless legs syndrome

In most cases, it is not known what causes restless legs syndrome. This is called primary, or idiopathic, RLS.

Sometimes restless legs syndrome is caused by another health condition. This is known as secondary RLS.

Primary restless legs syndrome

Primary restless legs syndrome tends to begin slowly, around the age of 40. This is earlier than most secondary RLS cases. RLS also runs in families, suggesting a genetic link.[12][15]

There is research that suggests restless legs syndrome may be connected to problems with a part of the brain called the basal ganglia, which uses dopamine to control muscle movement. If transmission of dopamine signals in this part of the brain becomes impaired, it can result in muscle spasms and jerky movements.[1]

Secondary restless legs syndrome

There are a number of factors that appear to be linked to restless legs syndrome. These may include:

Iron deficiency anemia

A lack of iron in the body, leading to iron deficiency anemia[16], appears to be linked to restless legs syndrome.[17] Iron plays a role in the functioning of dopamine and other neurotransmitters’ function in the brain.

Read more about iron deficiency anemia »

Restless legs syndrome and pregnancy

Pregnant women may develop restless legs syndrome, with symptoms more common in the final trimester. Between 10 percent and 25 percent of pregnant women are thought to experience symptoms.[18]

Nobody is quite sure why pregnancy can trigger restless legs syndrome. There are suggestions it may be connected to:[18]

  • Low iron levels
  • Low folate levels
  • Circulation problems
  • Increase in estrogen

Restless legs syndrome that develops during pregnancy very often goes away within a month after birth.[1]

Conditions often observed alongside restless legs syndrome

There are several conditions that can lead to restless legs syndrome as a complication, or have been linked to it, sometimes without yet fully understanding the mechanisms behind the link, such as:[2][15][11]

Restless legs syndrome triggers

Many medications and other substances can make restless legs syndrome worse, or rarer even cause it, these include such as:[2][15][19][20]

  • Certain antidepressants, including selective serotonin reuptake inhibitors (SSRIs), Serotonin-norepinephrine reuptake inhibitors (SNRIs) and tricyclic antidepressants (TCAs)
  • Metoclopramide, an anti-nausea medication
  • Certain antipsychotic medications, such as haloperidol and phenothiazines
  • Lithium, used to treat bipolar disorder or sometimes for severe depressions
  • Diphenhydramine, an antihistamine, found in cold and allergy medications
  • Calcium channel blockers, used to treat high blood pressure
  • Beta blockers, used to treat blood pressure and heart conditions
  • Caffeine and alcohol
  • Smoking tobacco

Diagnosis of restless legs syndrome

These are the diagnostic criteria for RLS, published by the International Restless Legs Syndrome Study Group (IRLSSG). All five criteria are required for the diagnosis:[11]

An urge to move the legs, usually caused by uncomfortable and unpleasant sensations in the legs. Sometimes the urge to move is present without the sensations, and sometimes the arms or other body parts are involved as well as the legs.

The urge to move or sensations in the limbs begin or become worse while resting.

The urge to move or sensations in the limbs are partially or totally eased by moving. Relief lasts as long as the movement continues.

The urge to move or sensations in the limbs are worse in the evening or night or only happen in the evening or night.

Symptoms are not explained by another medical or behavioral condition.

Check whether this matches your symptoms with the Adoctor conditions and symptoms.

A doctor will diagnose based on a description of symptoms and triggers. A physical and/or neurological exam may be done, a family history taken, and possibly blood tests to look for underlying factors or other treatable conditions.[2]

The asleep study may be helpful to check for sleep disruption and periodic limb movement in sleep.

The Restless Legs Syndrome Foundation[6] produces an RLS Symptom Diary[21] which can be printed off and used to track symptoms, activities, and sleep patterns. RLS-UK also has a tool to help affected people monitor symptoms and medication.[22]

Restless leg syndrome in children

There is thought to be a genetic link with restless legs syndrome, especially with primary restless legs syndrome. The Restless Legs Syndrome Foundation reports that 35 percent of people with the condition say they first experienced symptoms before the age of 20 and that 1.5 million children and adolescents in the United States are believed to be affected.[23]

Children with RLS are likely to be tired during the day, due to disturbed sleep. This can affect their performance in school, social functioning, and interactions with peers and family.

RLS is usually diagnosed based on a person’s description of their symptoms. However, it can be difficult for children to express what they are experiencing and accurately report their symptom history. Children exhibiting twitching and fidgeting may be mistaken for having ADHD. There is research to suggest 25 percent of children with RLS or periodic limb movements in sleep may be misdiagnosed as having ADHD.[24]

Treatment of restless legs syndrome

There is often no cure for primary restless legs syndrome, though its symptoms can be managed to make the condition easier to live with.

If restless legs syndrome is caused by a condition or medication, symptoms may go away and not return if the condition is cured or the causative medication is stopped. For example:[2][25]

  • RLS caused by pregnancy typically ends within four weeks after giving birth
  • Treating iron deficiency with iron supplements may cause an associated RLS to go away
  • RLS caused or made worse by a medication may be treated by stopping or changing medication, after consultation with a medical professional

Good to know: Stopping taking or changing any prescribed medication, without first seeking medical advice, can lead to serious health problems.

Iron supplements

Where restless legs syndrome is thought to be caused by an iron deficiency anemia, a lack of iron and/or ferritin in the body, treatment with iron supplements is advised.

A blood test, physical examination, and discussion with a doctor will establish the appropriate amount of iron supplements per day, possibly taken alongside supplements of vitamin C to help absorption. If this does not affect iron levels, less commonly, an intravenous infusion may be necessary.[1][26]

Side effects of taking more than 20mg of iron a day can include:[27]

Taking extremely high doses of iron can be dangerous. Although iron supplements are commonly available, treating restless legs syndrome with iron should be supervised by a medical professional.

Lifestyle management and home remedies

If the symptoms of restless legs syndrome are mild, lifestyle changes may be the only treatment needed. In these cases, there are plenty of natural treatments and home remedies that can be tried.[1][2][28][29]

Adopting good sleep practices can help a person with restless legs syndrome get enough sleep. Not getting enough sleep can be one of the most disruptive consequences of RLS. Good sleep habits can include:

  • Going to bed and waking up at regular times, even on the weekends or days off
  • Not napping during the day
  • Making sure the bedroom is dark, cool, quiet and comfortable
  • Taking electronic equipment, such as TV and phone, out of the bedroom

Changes to the diet may also help with reducing symptoms of restless legs syndrome:

  • Avoid stimulants, like caffeine, nicotine and alcohol, particularly before bed
  • Drink plenty of water to prevent dehydration

Certain activities can ease restless legs syndrome symptoms, such as:[28][29]

  • Regular, moderate exercise
  • Avoid being confined in places, for example, choose an aisle seat at the movies or on a plane
  • Massaging the legs
  • Taking a warm bath
  • RLS-UK suggests hot-cold therapy, a shower of alternating hot and cold water
  • Simple leg stretches or getting up and walking a little as often as possible may help in confined spaces like a plane, as well as in daily life when e.g. working a desk job sitting all day

Good to know: There are reports that drinking quinine tonic water, or placing a bar of soap under a bedsheet at night, will help; however, there is no scientific evidence for these activities, and any benefit is likely to be from the placebo[30] effect.

Medical devices

The U.S. Food and Drug Administration has approved devices to treat restless legs syndrome[1], including a foot wrap[31] and a vibrating pad. This pad, called Relaxis®, has been found to improve the quality of sleep.[32][33]

Restless legs syndrome medication

In more severe cases of RLS or when other treatments do not improve symptoms sufficiently, a medical professional may recommend medication for the condition.

Dopamine agonists

A class of drugs called dopamine agonists works by mimicking dopamine in the brain to stimulate a response. They are also often used to treat Parkinson’s disease.[34]

Multiple types of dopamine agonists have been approved to treat restless legs syndrome, among them:[1][35][36]

  • Bromocriptine
  • Ropinirole
  • Pramipexole
  • Rotigotine, taken as a skin patch

Side effects of these drugs can include:

  • Nausea
  • Sleepiness
  • Headaches
  • Dizziness
  • Fainting when standing up

Levodopa

Levodopa is a drug that the body converts into dopamine. It is usually taken alongside a drug called carbidopa, which stops levodopa from being converted into dopamine before reaching the brain.[37][38]

Sudden drowsiness and falling asleep can be a side effects of taking levodopa. It is advisable not to drive, operate machinery or take part in potentially dangerous activities until it’s clear how levodopa affects the person taking it.[38]

Levodopa is not recommended for long-term use as it can make restless legs syndrome symptoms worse. It’s generally prescribed for occasional, short-term use, e.g. when people feel symptoms coming on.

Anti-seizure medication

The U.S. Food and Drug Administration (FDA) has approved gabapentin enacarbil for treating restless legs syndrome. Two other anti-seizure medications, pregabalin, and gabapentin are being trialed, but not currently approved by the FDA for RLS treatment.[26]

A long-release form of gabapentin enacarbil is used to treat restless legs syndrome. The medication decreases the uncomfortable, creeping feelings in the legs.[1][39]

Possible side effects, which lessen over time, of gabapentin enacarbil include:[39]

  • Fatigue, a strong physical tiredness
  • Feeling dizzy
  • Feeling sleepy

Gabapentin enacarbil appears to be as effective or better at treating symptoms of restless legs syndrome as the dopamine agonist pramipexole. It seems to be of particular benefit to people with RLS, who are: [26][11]

  • In pain
  • Experiencing disturbed sleep as the primary symptom
  • Having difficulty with impulse control

Sleep aids

One of the most disruptive effects of restless legs syndrome can be lack of sleep. Medication from the benzodiazepine class of drugs, also known as hypnotics, may be prescribed as a short-term solution to help induce sleep.[26]

Benzodiazepines can include:[1][26]

  • Temazepam
  • Clonazepam
  • Lorazepam
  • Zaleplon
  • Eszopiclone

These drugs are not recommended for long-term use because of their various side effects, which include:[1][40]

  • Feeling sleepy during the day
  • Lack of concentration
  • Feeling sluggish
  • Causing or worsening sleep apnea
  • High risk of addiction

Augmentation and rebound

There are complications associated with dopamine medication used for treating restless legs syndrome.

Augmentation is the name for symptoms worsening under long-term use of certain medications for restless legs syndrome. People experiencing augmentation often find that symptoms start earlier in the day, start quicker once they rest, and the symptoms become more severe or spread further than previously.[41][36]

Augmentation is more common with long-term levodopa use, seen in possibly up to 80 percent of cases as opposed to longer-term dopamine agonist use, where this is generally seen in less than 30 percent of cases. It tends to occur around six months after starting a particular treatment.[42]

Ending the treatment will likely relieve signs of augmentation. However, coming off the drugs may be difficult as withdrawal symptoms can occur.[43][35]

Good to know: To date, gabapentin enacarbil, an alternative to dopamine medication, has not been shown to cause augmentation.[26]

Rebound occurs when restless legs syndrome symptoms appear in the morning or late at night and is related to a dose of the drug wearing off. It is differentiated from augmentation by lacking a worsening in severity of symptoms and of symptoms recurring at a different time of day; rebound often occurs in the morning as opposed to during the evening, as seen in augmentation.[35][42]

As with augmentation, the rebound can be halted and reversed by stopping taking the medication. Rebound can also be counteracted with longer-acting medication formulations.

Treatment of restless legs syndrome in children

The US Food and Drug Administration has not approved any medication for treating restless legs syndrome in children. The long-term effects of treating children with medication approved for adults are unknown.[44]

Benzodiazepines, such as clonazepam, are not recommended for children because they can increase the risk of collapse of the upper airway. Up to 20 percent of children taking levodopa and carbidopa develop a side effect of feeling nauseous.[44]

Good sleep habits are recommended for treating restless legs syndrome in children, as is avoiding caffeine and antihistamines. Vitamin and mineral supplements may help when taken in consultation with a doctor.[24][44]

Restless legs syndrome FAQs

  1. National Institute of Neurological Disorders and Stroke. “Restless Legs Syndrome Fact Sheet.” May 2017. Accessed April 6, 2018. ↩ ↩ ↩ ↩ ↩ ↩ ↩ ↩ ↩ ↩ ↩ ↩ ↩ ↩ ↩

  2. National Heart, Lung, and Blood Institute, “Restless Legs Syndrome.” Accessed April 6, 2018. ↩ ↩ ↩ ↩ ↩ ↩ ↩ ↩

  3. MedlinePlus. “Restless Legs.” March 2018. Accessed April 6, 2018. ↩ ↩

  4. Centers for Disease Control and Prevention. “Key Sleep Disorders.” December 2014. Accessed April 6, 2018. ↩

  5. Sleep Education. “Restless Legs Syndrome – Causes and Symptoms.” Accessed April 6, 2018. ↩

  6. Restless Legs Syndrome Foundation. “Symptoms & DIagnosis.” Accessed April 6, 2018. ↩ ↩ ↩

  7. Genetics Home Reference. “Restless legs syndrome.” May, 2018. Accessed: 14 November, 2018. ↩

  8. Genetics Home Reference. “Restless legs syndrome.” May, 2018. Accessed: 14 November, 2018. ↩

  9. Parkinson’s UK. “Restless legs.” Accessed April 6, 2018. ↩

  10. John Hopkins Medicine. “What is Restless legs Syndrome (RLS?)” Accessed April 6, 2018. ↩ ↩

  11. UpToDate. “Clinical features and diagnosis of restless legs syndrome and periodic limb movement disorder in adults.” February 2018. Accessed May 7, 2018. ↩ ↩ ↩ ↩ ↩

  12. RLS-UK. “What is RLS?” Accessed April 6, 2018. ↩ ↩

  13. RLS-UK. “Periodic Leg Movement (PLMD).” Accessed April 6, 2018. ↩ ↩

  14. AAST. “Treatment of Restless Leg Syndrome and Periodic Limb Movement Disorder.” March 2016. Accessed April 6, 2018. ↩

  15. Restless Legs Syndrome Foundation. “Frequently Asked Questions.” Accessed April 6, 2018. ↩ ↩ ↩ ↩

  16. MedlinePlus. “Iron deficiency anemia.” March 2018. Accessed April 6, 2018. ↩

  17. US National Library of Medicine. “The role of iron in restless legs syndrome.” 2007. Accessed April 6, 2018. ↩

  18. RLS-UK. “RLS in Pregnancy.” Accessed April 6. 2018. ↩ ↩

  19. RLS-UK. “Treatment.” Accessed April 6, 2018. ↩

  20. Medscape. “Restless Legs Syndrome.” February, 2017. Accessed May 7, 2018. ↩

  21. Restless Legs Syndrome Foundation. “RLS Symptom Diary.” 2018. Accessed April 6, 2018. ↩

  22. RLS-UK. “RLS Monitor.” August 2014. Accessed April 6, 2018. ↩

  23. Restless Legs Syndrome Foundation. “RLS & Kids.” Accessed April 6, 2018. ↩

  24. RLS-UK. “RLS in Children.” Accessed April 6, 2018. ↩ ↩

  25. RLS-UK. “Is there a link between iron levels and RLS?” January 2017. Accessed April 6, 2018. ↩

  26. Johns Hopkins Medicine. “Treatment for restless legs syndrome (RLS).” Accessed April 8, 2018. ↩ ↩ ↩ ↩ ↩ ↩

  27. NHS Choices. “Iron.” March 2017. Accessed April 8, 2018. ↩

  28. RLS-UK. “Self-Management of RLS.” Accessed April 6, 2018. ↩ ↩ ↩ ↩

  29. Restless Legs Syndrome Foundation. “Lifestyle. Accessed April 6, 2018. ↩ ↩

  30. A placebo effect is when some sort of positive effect is seen following a treatment that can not have scientifically, logically been caused by that treatment or medication itself. This improvement can sometimes be because a person simply believes that they feel better, but placebos, sometimes also called sugar pills, have also been observed to actually improve symptoms in some cases. ↩ ↩

  31. U.S. Food & Drug Administration. “Foot Wrap For Treating Restless Leg Syndrome Symptoms.” February 2018. Accessed April 8, 2016. ↩

  32. The Relaxis® treatment is not affiliated with Ada, and is mentioned here in order to provide a full overview of current treatment options for RLS. ↩

  33. US National Library of Medicine. [“Medical devices for restless legs syndrome – clinical utility of the Relaxis pad.]”(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4671777/) December 2015. Accessed April 8, 2018. ↩

  34. Parkinson’s UK. “Dopamine agonists.” August 2015. Accessed April 8, 2018. ↩

  35. Restless Legs Syndrome Foundation. “What is Augmentation?” 2018. Accessed April 8, 2016. ↩ ↩ ↩

  36. Medscape. “Restless Legs Syndrome Treatment & Management.” 22 February, 2017. Accessed: 14 November, 2018. ↩ ↩

  37. Parkinson’s UK. “Levodopa.” August 2015. Accessed April 8, 2018. ↩

  38. MedlinePlus. “Levodopa and Carbidopa.” October 2015. Accessed April 8, 2018. ↩ ↩

  39. MedlinePlus. “Gabapentin.” November 2017. Accessed April 8, 2018. ↩ ↩

  40. National Institute for Health and Care Excellence. “Clinical Knowledge Summaries: Insomnia.” April 2015. Accessed April 8, 2018. ↩

  41. Johns Hopkins Medicine. “Dopamine Drugs and Possible Side Effects.” Accessed April 8, 2018. ↩

  42. RLS-UK, “Augmentation & Rebound.” Accessed April 8, 2018. ↩ ↩

  43. Medscape. [“Restless Legs Syndrome: A Unique Case and Essentials of Diagnosis and Treatment.”] 2008. Accessed: 14 November, 2018. ↩

  44. US National Library of Medicine. “Restless legs syndrome in Children.” June 2006. Accessed April 8, 2018. ↩ ↩ ↩

  45. US National Library of Medicine. “Magnesium therapy for periodic leg movements-related insomnia and restless legs syndrome: an open pilot study.” August 1998. Accessed April 6, 2018. ↩

  46. US National Library of Medicine. “The effect of magnesium supplementation on primary insomnia in elderly: A double-blind placebo-controlled clinical trial.” December 2012. Accessed April 6, 2018. ↩

  47. Harvard Health Publishing. “Sleep and magnesium supplements.” January 2016. Accessed April 6, 2018. ↩

  48. NHS Choices. “Why lack of sleep is bad for your health.” June 2015. Accessed April 8, 2018. ↩


**What is Restless Legs Syndrome?**



**Q: What is Restless Legs Syndrome (RLS)?**



**A:** Restless Legs Syndrome (RLS), also known as Willis-Ekbom Disease, is a neurological disorder characterized by an irresistible urge to move the legs, usually accompanied by uncomfortable⁢ sensations in the legs.



**Q: What are the symptoms of RLS?**



**A:** Common symptoms include:

* Uncomfortable sensations ⁢in​ the legs, described as ‍crawling, tingling, or burning

* An irresistible urge ​to move the ⁢legs ​to relieve the discomfort

* Worsening symptoms in the​ evening or at night

* ​Relief from symptoms with leg movements, such as walking or stretching



**Q: What causes RLS?**



**A:** The exact cause of RLS is unknown, but it’s thought to be related to:

* Imbalances in neurotransmitters, such as ⁤dopamine

* Genetic factors

* Iron deficiency

* Pregnancy

* Chronic conditions (e.g., diabetes, Parkinson’s disease)



**Q: How is ‌RLS diagnosed?**



**A:** Diagnosis is based on a physical exam, medical history, and criteria from the International Restless Legs Syndrome Study Group.



**Q: How is RLS treated?**



**A:** Treatment aims ‌to relieve symptoms and improve sleep. Options include:

* ⁢Medications: Dopamine agonists,‌ Alpha-2-delta ligands, Anticonvulsants

* Lifestyle modifications: Avoiding caffeine ‍and alcohol, Regular exercise, Iron supplements (if deficient)

* Alternative therapies: Acupuncture, Massage, Transcutaneous electrical nerve stimulation (TENS)



**Q: Can RLS be cured?**



**A:** Currently, there is no cure for RLS, but treatments can effectively manage symptoms.



**Q: What are the⁣ long-term effects of RLS?**



**A:** Chronic RLS‌ can lead to:

* Sleep deprivation and⁤ fatigue

* Impaired social and⁤ occupational function

* ⁤Depression and anxiety



**Q: Who is at risk for developing RLS?**



**A:** Factors that increase the risk of RLS include:

* Family history

* Pregnancy

* Iron deficiency

* Certain medications

* Chronic medical conditions (e.g., diabetes, Parkinson’s disease)



**Keywords:**



* ⁣Restless Legs Syndrome

* Willis-Ekbom Disease

*‍ RLS symptoms

* RLS causes

* RLS diagnosis

* RLS treatment

* RLS cure

* RLS long-term effects

* RLS risk factors

* Neurological disorder

* Sleep ⁢disorder

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2 Comments

  1. Restless legs syndrome (RLS), also known as Willis-Ekbom disease, is a common neurological disorder that causes an irresistible urge to move your legs, usually accompanied by uncomfortable sensations. It typically worsens in the evening or at night, and can make it difficult to fall or stay asleep.

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